Gastroenterology

Gastroenterology

Volume 124, Issue 2, February 2003, Pages 303-317
Gastroenterology

Clinical–Alimentary Tract
The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome

https://doi.org/10.1053/gast.2003.50055Get rights and content

Abstract

Background & Aims: Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established. Methods: Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibitor (SSRI) antidepressant, paroxetine, or routine care by a gastroenterologist and general practitioner. Primary outcome measures of abdominal pain, health-related quality of life, and health care costs were determined after 3 months of treatment and 1 year later. Results: A total of 257 subjects (81% response rate) from 7 hospitals were recruited; 59 of 85 patients (69%) randomized to psychotherapy and 43 of 86 (50%) of the paroxetine group completed the full course of treatment. Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life (SF-36 physical component score improvement, 5.2 [SEM, 1.26], 5.8 [SEM, 1.0], and −0.3 [SEM, 1.17]; P < 0.001), but there was no difference in the psychological component. During the follow-up year, psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual (psychotherapy, $976 [SD, $984]; paroxetine, $1252 [SD, $1616]; and treatment as usual, $1663 [SD, $3177]). Conclusions: For patients with severe IBS, both psychotherapy and paroxetine improve health-related quality of life at no additional cost.

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Supported by the Medical Research Council of the United Kingdom and the North Western Region Health Authority (U.K.) R & D Directorate. SmithKlineBeecham provided the paroxetine but was not involved in the design, conduct, or analysis of the trial.

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